Fibrosis score 4 index has an independent relationship with coronary artery diseases in patients with metabolic-associated fatty liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) biomarkers and progression of lower limb arterial calcification in patients with type 2 diabetes: a prospective cohort study

BACKGROUND

Studies have demonstrated that both lower limb arterial calcification and metabolic dysfunction-associated steatotic liver disease (MASLD) are linked to the development of peripheral artery disease. However, the potential relationship between MASLD biomarkers and progression of lower limb arterial calcification in individuals with type 2 diabetes (T2D) remains unclear. This study aimed to investigate whether the biomarkers of MASLD included in the FibroMax® panels are associated with the progression of lower limb arterial calcification in patients with T2D.

METHODS

The lower limb arterial calcification score (LLACS) was evaluated through computed tomography at baseline and after an average follow-up of 31.2 ± 3.7 months in a cohort of 150 patients with T2D. We also measured the serum biomarkers included in the FibroMax® panels (SteatoTest®, FibroTest®, NashTest®, ActiTest®). The predictive ability of these biomarkers of MASLD on LLACS progression was assessed through univariate and multivariate linear regression models, principal component regression analysis, as well as machine learning algorithms.

RESULTS

During the follow-up period, LLACS increased in 127 (85%) of the 150 patients with T2D. In univariate analysis, the annualized change in LLACS was positively and mainly correlated with baseline LLACS (r = 0.860, p < 0.0001), the FibroTest® score (r = 0.304, p = 0.0002), and age (r = 0.275, p = 0.0006), and negatively correlated with glomerular filtration rate (r = - 0.242, p = 0.003). In multivariate analysis, the FibroTest® score remained independently associated with the annualized change in LLACS, after adjusting for baseline LLACS and risk factors for lower extremity artery disease (β coefficient [95% confidence interval]: 988 [284-1692], p = 0.006). This association persisted even after adjustment for variables selected by principal component analysis (β = 1029 [289-1768], p = 0.007). Two advanced machine learning models identified the FibroTest® score as the second most important predictor of annualized change in LLACS, following baseline LLACS.

CONCLUSIONS

This study represents the first demonstration of an independent relationship between a non-invasive liver fibrosis test and the progression of lower limb arterial calcification in patients with T2D. Beyond its utility in assessing liver fibrosis, the FibroTest® could be a valuable and easy-to-use biomarker for predicting the risk of worsening lower limb arterial calcification.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02431234.

Predictive value of the FIB-4 index in ST-elevation myocardial infarction patients: from admission to follow-up

BACKGROUND

ST-elevation myocardial infarction (STEMI) remains a leading cause of global mortality despite advancements in primary percutaneous coronary intervention (PCI). The fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis, has been associated with cardiovascular outcomes. However, its predictive value for in-hospital and post-discharge all-cause mortality in STEMI patients undergoing PCI remains uncertain. This study aimed to evaluate the prognostic utility of the FIB-4 index in this high-risk population.

METHODS

This retrospective study analysed 2186 STEMI patients who underwent PCI. Patients were categorised into three groups based on FIB-4 tertiles: Group 1 (FIB-4 < 4.52), group 2 (4.52 ≤ FIB-4 < 6.07), and group 3 (FIB-4 ≥ 6.07). Logistic regression assessed predictors of in-hospital mortality, while Kaplan-Meier's survival analysis and Cox proportional hazards models were used to evaluate post-discharge mortality.

RESULTS

In-hospital mortality was significantly higher in group 3 (4.3%) compared to group 2 and group 1 (p = .016). The FIB-4 index was an independent predictor of in-hospital mortality (OR: 1.105, 95% CI: 1.011-1.207, p = .028), alongside Killip class ≥ II, diabetes mellitus and reduced eGFR < 76.8 mL/min. During a median follow-up of 21 months post-discharge, all-cause mortality occurred in 8% of patients (n = 178), with rates highest in group 3 (10%, n = 74) compared to group 2 and group 1 (p = .002). Kaplan-Meier's survival analysis demonstrated significantly lower cumulative survival in group 3 (log-rank test, p = .003). Multivariable Cox analysis confirmed an increased post-discharge mortality risk in group 3 (HR: 1.862, 95% CI: 1.254-2.764, p = .002) compared to group 1.

CONCLUSIONS

The FIB-4 index independently predicts in-hospital and post-discharge all-cause mortality in STEMI patients undergoing PCI. Its integration into clinical practice could improve risk stratification and patient management.

Association between coronary heart disease and risk of advanced liver fibrosis: results of the 2017-2018 national health and nutrition examination survey

BACKGROUND

Studies have shown that advanced liver fibrosis is strongly associated with cardiovascular risk factors (including age and smoking status). Nevertheless, the exact mechanism is not yet clear. Hence, this study aimed to investigate the relationship between coronary heart disease (CHD) and advanced liver fibrosis and to reveal the developmental processes.

METHODS

In this study, we included 9254 participant data from the National Health and Nutrition Examination Surveydatabases in 2017-2018 to explore the association between risk factors and advanced liver fibrosis. First, the baseline characteristics of the participants were examined using Student's t-test and chi-squared test. Moreover, the association between CHD and advanced liver fibrosis was assessed using logistic regression analysis. Thereafter, the receiver operating characteristic curve was used to further evaluate the diagnostic performance of model 3 for advanced liver fibrosis.

RESULTS

In total, 3624 participants were included in this study after removing samples with missing information. Baseline statistics showed that CHD, age, sex, BMI, alcohol consumption, smoking, diabetes, and physical activity were all remarkably discrepancies between nonadvanced and advanced liver fibrosis groups (P < 0.05). Of these, CHD was shown to have a strong association with advanced liver fibrosis (95% confidence interval (CI), 1.84-7.27, P = 0.0063, odds ratio (OR) = 3.6587). Moreover, the effect of CHD on advanced liver fibrosis was not confounded by other confounders in model 3, in which confounders were corrected. Eventually, with an area under the curve greater than 0.7, the receiver operating characteristic curve confirmed the good diagnostic performance of Model 3 for advanced liver fibrosis.

CONCLUSION

This study suggested that having CHD was a risk factor for patients with advanced liver fibrosis, which provides a basis for the study of advanced liver fibrosis.

Estimating the prevalence of adults at risk for advanced hepatic fibrosis using FIB-4 in a Swiss tertiary care hospital

BACKGROUND & AIMS

Chronic liver diseases pose a serious public health issue. Identifying patients at risk for advanced liver fibrosis is crucial for early intervention. The Fibrosis-4 score (FIB-4), a simple non-invasive test, classifies patients into three risk groups for advanced fibrosis. This study aimed to estimate the prevalence of patients at risk for advanced hepatic fibrosis at a Swiss tertiary care hospital by calculating the FIB-4 score in routine blood analysis.

METHODS

A retrospective study was conducted using data from 36,360 patients who visited outpatient clinics at eight main clinics of the University Hospital Bern in Switzerland. The data collection period ran from January 1st to December 31st, 2022. Patients attending the hepatology outpatient clinic were excluded. We then calculated the overall and clinic-specific prevalence of patients falling into the high risk category for advanced fibrosis according to FIB-4.

RESULTS

Among the 36,360 patients, 26,245 (72.2%) had a low risk of advanced fibrosis (FIB-4 <1.3), whereas 3913 (10.8%) and 2597 (7.1%) patients were flagged to have a high risk of advanced fibrosis (FIB-4 >2.67 and FIB-4 >3.25 respectively). Geriatrics and Cardiology had the highest proportions of patients at risk for advanced fibrosis over all clinics.

CONCLUSIONS

This study demonstrates a high prevalence of high FIB-4 score in a Swiss tertiary care hospital. The implementation of the automatically generated FIB-4 score in daily practice, not only in primary care, but also within tertiary care hospitals, could be crucial for early identification of outpatients at high risk of advanced liver fibrosis requiring further hepatological investigations.

Metabolic Dysfunction Associated-Steatotic Liver Disease (MASLD) and Cardiovascular Risk: Embrace All Facets of the Disease

PURPOSE OF REVIEW

In recent years, the terms "metabolic associated fatty liver disease-MAFLD" and "metabolic dysfunction-associated steatotic liver disease-MASLD" were introduced to improve the encapsulation of metabolic dysregulation in this patient population, as well as to avoid the negative/stigmatizing terms "non-alcoholic" and "fatty".

RECENT FINDINGS

There is evidence suggesting links between MASLD and coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke, peripheral artery disease (PAD) and chronic kidney disease (CKD), although the data for HF, AF, stroke and PAD are scarcer. Physicians should consider the associations between MASLD and CV diseases in their daily practice. Based on this knowledge and current guidelines, they should also assess and manage CV risk/co-morbidities in such patients. It is important to further investigate the impact of MASLD on CV outcomes, a knowledge that will help to elucidate the clinical implications of this "novel" liver entity.

Impact of alcohol consumption on metabolic dysfunction-associated fatty liver disease development and remission: A longitudinal cohort study

BACKGROUND

The influence of alcohol intake on metabolic dysfunction-associated fatty liver disease (MAFLD) development and remission remains unclear; thus, we aimed to investigate their longitudinal associations.

METHODS

This observational cohort study included 6349 patients who underwent more than two health check-ups over >2 years between April 2013 and March 2021. Generalized estimation equations were used to analyse the longitudinal associations between changes in alcohol intake and MAFLD according to repeated measures at baseline and the most recent stage.

RESULTS

The MAFLD development and remission rates were 20.4 and 5.1 and 9.1 and 4.7% in men and women, respectively. Although alcohol consumption was not a significant factor for MAFLD development, consuming 0.1-69.9 g/week (odds ratio [OR]: 0.672, 95% confidence interval [CI]: 0.469-0.964, p < .05) and ≥280 g/week were significant factors for MAFLD development in males (OR: 1.796, 95% CI: 1.009-3.196, p < .05) and females (OR: 16.74, 95% CI: 3.877-72.24, p < .001). Regardless of quantity and frequency, alcohol consumption was not a significant factor for MAFLD remission. Several noninvasive liver fibrosis scores were significantly associated with alcohol intake quantity and frequency in males with MAFLD development and remission (p < .05). The nonalcoholic fatty liver disease fibrosis score differed significantly between males with and without reduced alcohol intake (p < .05) who showed MAFLD remission.

CONCLUSIONS

Although the influence of alcohol intake on MAFLD development and remission differed, alcohol consumption was not beneficial for MAFLD remission in either sex. Alcohol intake reduction or cessation is recommended to prevent liver fibrosis, even in those who achieve MAFLD remission.

Non-alcoholic fatty liver disease biomarkers estimate cardiovascular risk based on coronary artery calcium score in type 2 diabetes: a cross-sectional study with two independent cohorts

BACKGROUND

Studies have demonstrated that coronary artery calcification on one hand and non-alcoholic fatty liver disease (NAFLD) on the other hand are strongly associated with cardiovascular events. However, it remains unclear whether NAFLD biomarkers could help estimate cardiovascular risk in individuals with type 2 diabetes (T2D). The primary objective of the present study was to investigate whether the biomarkers of NAFLD included in the FibroMax® panels are associated with the degree of coronary artery calcification in patients with T2D.

METHODS

A total of 157 and 460 patients with T2D were included from the DIACART and ACCoDiab cohorts, respectively. The coronary artery calcium score (CACS) was measured in both cohorts using computed tomography. FibroMax® panels (i.e., SteatoTest®, FibroTest®, NashTest®, and ActiTest®) were determined from blood samples as scores and stages in the DIACART cohort and as stages in the ACCoDiab cohort.

RESULTS

CACS significantly increased with the FibroTest® stages in both the DIACART and ACCoDiab cohorts (p-value for trend = 0.0009 and 0.0001, respectively). In DIACART, the FibroTest® score was positively correlated with CACS in univariate analysis (r = 0.293, p = 0.0002) and remained associated with CACS independently of the traditional cardiovascular risk factors included in the SCORE2-Diabetes model [β = 941 ± 425 (estimate ± standard error), p = 0.028]. In the ACCoDiab cohort, the FibroTest® F3-F4 stage was positively correlated with CACS in point-biserial analysis (rpbi = 0.104, p = 0.024) and remained associated with CACS after adjustment for the traditional cardiovascular risk factors included in the SCORE2-Diabetes model (β = 234 ± 97, p = 0.016). Finally, the prediction of CACS was improved by adding FibroTest® to the traditional cardiovascular risk factors included in the SCORE2-Diabetes model (goodness-of-fit of prediction models multiplied by 4.1 and 6.7 in the DIACART and ACCoDiab cohorts, respectively). In contrast, no significant relationship was found between FibroMax® panels other than FibroTest® and CACS in either cohort.

CONCLUSIONS

FibroTest® is independently and positively associated with the degree of coronary artery calcification in patients with T2D, suggesting that FibroTest® could be a relevant biomarker of coronary calcification and cardiovascular risk.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers NCT02431234 and NCT03920683.

Biomarkers of Hepatic Dysfunction and Cardiovascular Risk

PURPOSE OF REVIEW

The objective of this manuscript is to examine the current literature on non-alcoholic fatty liver disease (NAFLD) biomarkers and their correlation with cardiovascular disease (CVD) outcomes and cardiovascular risk scores.

RECENT FINDINGS

There has been a growing appreciation for an independent link between NAFLD and CVD, culminating in a scientific statement by the American Heart Association in 2022. More recently, studies have begun to identify biomarkers of the three NAFLD phases as potent predictors of cardiovascular risk. Despite the body of evidence supporting a connection between hepatic biomarkers and CVD, more research is certainly needed, as some studies find no significant relationship. If this relationship continues to be robust and readily reproducible, NAFLD and its biomarkers may have an exciting role in the future of cardiovascular risk prediction, possibly as risk-enhancing factors or as components of novel cardiovascular risk prediction models.

Association between Major Adverse Cardiovascular Events and the Liver Fibrosis Score in Patients with and without Coronary Artery Disease: From the FU-CCTA Registry

The liver fibrosis score reflects the degree of hepatic scarring and has been reported to be associated with cardiovascular disease. Using a coronary artery computed tomography angiography registry at the Fukuoka University Hospital (FU-CCTA registry), we investigated the association between major adverse cardiovascular events (MACEs) and the liver fibrosis score (fibrosis-4 index (FIB-4I)) in 612 patients who underwent CCTA to screen for coronary artery disease and performed a prognosis survey for up to 5 years. The primary endpoint was MACEs (all-cause mortality, acute myocardial infarction, ischemic stroke, coronary revascularization). FIB-4I in all patients and in patients with hypertension (HTN) was significantly higher in the MACE group than in the non-MACE group. The event-free survival rate of MACEs targeting only patients with HTN was significantly lower in patients with a high risk of liver fibrosis (FIB-4I values of 2.67 or higher) than in those with a low or intermediate risk (less than 2.67). However, no significant difference was observed in all patients or in patients without HTN. Finally, FIB-4I and body mass index were independent factors associated with MACEs in patients with HTN. In conclusion, the liver fibrosis score may be an independent predictor of MACEs in hypertensive patients undergoing CCTA.

Investigating the Association between Coronary Artery Disease and the Liver Fibrosis-4 Index in Patients Who Underwent Coronary Computed Tomography Angiography: A Cross-Sectional Study

Liver fibrosis scores, indicative of hepatic scarring, have recently been linked to coronary artery disease (CAD). We investigated the association between CAD and the fibrosis-4 index (FIB-4I) in patients who underwent coronary computed tomography angiography (CCTA). This study included 1244 patients who were clinically suspected of having CAD. The presence or absence of CAD was the primary endpoint. FIB-4I was higher in the CAD group than in the non-CAD group (1.95 ± 1.21 versus [vs.] 1.65 ± 1.22, p < 0.001). FIB-4I was also higher in the hypertension (HTN) group than in the non-HTN group (1.90 ± 1.32 vs. 1.60 ± 0.98, p < 0.001). In all patients, high FIB-4I (≥2.67) was a predictor of presence of CAD (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.30-2.83, p = 0.001), and low FIB-4I (≤1.29) was proven to be a predictor of absence of CAD (OR: 0.65, 95% CI: 0.48-0.88, p = 0.006). In the HTN group, high and low FIB-4I levels, were found to be predictors for CAD (OR: 2.01, 95% CI: 1.26-3.21, p < 0.001 and OR: 0.65, 95% CI: 0.45-0.94, p < 0.022, respectively), in particular. FIB-4I may serve as a diagnostic indicator of the presence or absence of CAD in hypertensive patients undergoing CCTA.